Page 85 - Predicting survival in patients with spinal bone metastasesL

INTRODUCTION
Prediction of survival has become an integral part of selecting the appropriate treatment for patients suffering from symptomatic spinal bone metastases (SBM). Depending on the symptoms, patients with a short expected survival are most likely to benefit from short radiotherapy regimens, best supportive care or minimally invasive surgery. Patients with a relatively long expected survival will most likely benefit from high dose radiotherapy or – in the case of radioresistant tumors and biomechanical instability – more extensive surgical interventions. Several studies have shown that the estimation of survival by clinicians in terminally ill patients is inaccurate and have suggested the use of prognostication models in order to prevent exposure of patients to unnecessarily extensive treatments1-3.
Models to aid in the decision making process have been developed by Tokuhashi, Bauer – later modified by Leithner – Tomita, Van der Linden, Rades and Bollen4-10. These models make use of a combination of different risk factors to estimate the survival of individual patients. Several smaller studies have been undertaken to assess the predictive value of some of the models6,11-13, however, a large international validation study assessing all the models simultaneously has not yet been performed.
The aim of this study was to assess the validity and predictive accuracy of six models designed to estimate survival in a large cohort of patients with spinal bone metastases.
MATERIALS AND METHODS
In this international multicenter retrospective cohort study, all patients presenting with symptomatic SBM at two tertiary referral centers in Leiden, the Netherlands and Graz, Austria between January 2000 and December 2010 were included.
Patients were identified through database searches linking treatment and diagnostic codes and through database searches based on surgical coding. Information on date of death was obtained from medical records or by contacting the general practitioner or the civil registry office.
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SCORING SYSTEMS
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